February 1, 2015 was the day I broke free from the insurance run health care system. After several years of being a staff physician at a large health system, medical directorship, running research studies, writing articles, being a pharmaceutical consultant for 2 large companies, I realized I cannot change this system from within. Corporate greed was too great for a young physician to fight.
Each year I practiced medicine, I met another hard working American who waived his/her plastic insurance card, yet could not receive accessible or affordable primary care. I have met many other hard working Americans who couldn't get coverage regardless of the Affordable Care Act (ACA).
The final story I could tolerate came when I met a 35 year old female who suffered a massive stroke and had to have her skull drilled to relieve the growing pressure from a massive brain hemorrhage.
I took over her care after she had been moved from the ICU to the floor. My job was to figure out why she had the stroke, prevent the next stroke, and aggressively pursue rehab. I had triaged her as one of my last patients to see as she was reportedly stable.
I knocked on the door and found a young brown haired caucasian female laying quietly in a dark room, alone. Her hair was disheveled as she had staples on one side of her scalp with part of her head shaved, allowing exposure to her staples. She looked exhausted. Unlike the other rooms, there were no flowers, no cards, no "Get Well" balloons. It was just her, a beeping IV pump, and a computer next to her bed. The guest couch and chairs sat empty in the corner of the room. The 42 inch TV was turned off. The large window provided some light as it penetrated the dark window and the window shade. Upon my entrance, she turned to look at me with sad eyes and managed to smile half way.
I pulled up a chair next to her bed to listen to her story as I did with every patient. She readjusted herself, which was challenging as her entire right side was still weak.
You see, she was a young 35 year old single mom who was working 3 part-time jobs, because her employers did not want to offer a full time job as that would require them to offer her health insurance under the current laws. So, she did not have insurance because of this. Her story began with a visit to an urgent care center where she was told she had high blood pressure and she was given a medication to help control her blood pressure. She didn't understand what high blood pressure would mean if it is not controlled. After taking the medication for a few days, she simply stopped taking it because to her it was all numbers and certainly didn't make her feel any "better." Besides, she was a young 35 year old and so how bad could it be?
In reviewing her records, it seems she had presented to the ER with a blood pressure of 220/120. Likely, her blood pressure was the reason for her stroke and head bleed. The medication she was on for high blood pressure is $4. Needless to say, I can get this medication for my patients now for $0.87 for a month supply.
As her story continued to unravel, I started to stoop lower and lower in my chair. My mind started to race with anger. How can she be so abandoned? Why did no one tell her about the importance of blood pressure? Where was the follow up visit? How is this fair? She is a contributing American citizen to our economy, yet we abandon her?
To put all this in perspective, here she is as an uninsured patient with an ICU stay of 5 days, surgical drainage of blood, multiple imaging studies and labs, she couldn't move her entire right side and so will need 6-8 weeks of rehab. One of her jobs was being a waitress. There is no way she could return to this line of work. In essence, we have effectively bankrupted a young, sweet, innocent, 35 year old single mom.
After she had completed her story, teary eyed, and by now I was almost laying in my chair, I straightened myself and leaned forward towards her. I said,"ma'am, I am so sorry for all this. We have failed you. I as a representative of the American health care system have failed you. For that, I am sorry."
I went on to explain how important blood pressure is to control and how we can prevent another stroke. I left that room with only one thought in mind...NEVER AGAIN.
Never again would I allow myself to be in that chair hearing a story like that from any of my patients. My mind was made up to offer the best primary care I can, regardless of insurance status.
Many people do not hear the stories that we as physicians hear. Yes, you pay for insurance premiums, but for primary care, that insurance card likely is not getting you the best care. Think about it. Some pay $25 to over $100 in copay per visit for what? A 10-15 minute visit that feels rushed or is not comprehensive. Or be sent to a specialist, procedure, imaging study, or be prescribed pills when in reality you probably didn't need it. These decisions are made simply because there is no time to get to the root of the problem.
The follow up is the most important component of primary care. Start a gameplan and then you need to follow up maybe in a week or 2 weeks. But eliminate the copays that people have to pay to make the follow up more feasible. This is where direct care makes sense and saves money.
The young and healthy individuals also save money and gain value in a direct care model. Simply put, casting, medications, EKG, suturing is FREE or at a minimal cost in a direct care practice. Time and money is saved. But, think about the value. That young and healthy individual is probably going through some emotional roller coasters. What are their aspirations? How strong is their social network and who are they? Who do they spend time with and how are they dealing with any stressors they may have? Are they exercising and eating healthy? If they do exercise, then are they doing it safely? Do they practice safe sex? Where are they planning to travel? Are they overweight? Do they have family history of diabetes or heart disease that predisposes them to these conditions?
These questions are so important that essentially a life can be saved by simply talking to them. These young adults are connected to their physician by a simple text or video chat under a direct care model. How neat is that?
This is the value of direct care with or without health insurance. Take the time to understand what you are paying for when purchasing a health insurance plan. Our patients with Medicare and supplement insurance will say the value of access, coordination of care, and availability overwhelms the minimal monthly cost.
Health insurance and direct care together make a phenomenal resource for all Americans to live well. Quality of life will be enhanced. Our health expenditures will go down. Taxes will be reduced and employers will be able to retain their talented workforce. Increase in direct care practices will solve the primary care shortage, lead to more young physicians embracing private practice to revive the practice of medicine, technology will be used to bring accessible health care into the home, and the American people will be empowered to navigate the health care system with more confidence. Together, we will achieve a healthier America.
Give a direct primary care practice some consideration. Visit iwantdirectcare.com to learn where the nearest direct care practice is for you.
Welcome to the new US Health Care System!
"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."